不停跳和心肺转流下冠状动脉搭桥术后呼吸动力学的变化

Changes of respiratory mechanics after coronary surgery underwent off-pump and cardiopulmonary bypass

目的研究不停跳和心肺转流(CPB)下冠状动脉搭桥术对呼吸动力学的影响,并观察这些变化与时间的关系。方法择期行冠状动脉搭桥术的冠心病患者26例,根据是否应用CPB分成两组:CPB组(n=13)和不停跳冠状动脉搭桥组(OPC组,n=13)。在围术期用BICORECP-100呼吸功能监测仪监测胸肺顺应性、气道阻力、呼吸功等呼吸动力学指标的变化。结果两组的胸肺顺应性术后均出现降低,CPB组于术后3、6h较诱导后明显降低(P<0.05或P<0.01),术后10h基本恢复至诱导后水平;而OPC组术后3h较诱导后明显下降(P<0.05),术后10h基本恢复。两组的气道阻力术后均出现增加,CPB组于术后6h高于诱导后水平(P<0.05),然后逐渐下降;OPC组于术后3h高于诱导后水平(P<0.05),术后10h基本恢复。两组的呼吸功均于术后3h明显增加(P<0.05),至术后10h后基本恢复。两组间呼吸动力学的比较差异均无统计学意义。两组患者术后呼吸支持时间相同。结论不停跳冠脉搭桥与CPB下冠脉搭桥术对术后呼吸动力学的改变相似,因此术后早期拔管也应谨慎。

Objective To compare the effects of coronary surgery with and without cardiopul- monary bypass （CPB） on respiratory mechanics. Methods Two groups of patients （13 cases each） scheduled for elective coronary artery bypass grafting （CABG） with or without CPB were studied. Measurements of respiratory compliance, resistance and breathing work were performed by BICORE CP-100 monitor perioperatively. Results In both groups there was a significant decrease in respiratory compliance after operation. In the group with CPB the compliance decreased evidently at 3 and 6 h after operation（P〈 0. 05 or P〈0.01）and tended to be normal 10 h after operation, whereas the decrease in the off-pump group occurred mere significantly at 3 h after operation（P〈0.05）. Respiratory resistance was found to be significantly increased at 6 h after operation in the group with CPB （P〈0. 05） and at 3 h after operation in the off-pump group（P〈0. 05）, respectively. Breathing work clearly increased at 3 h after operation in both groups（P〈0.05）and tended to be normal 10 h after operation. No significant differences in respiratory mechanics between the two groups at any time points were noticed, so did in ventilator support time. Conclusion Coronary bypass surgery with and without CPB results in similar impairment of after CABG should be performed with caution, used, respiratory system mechanics, thus early extubation no matter whether the off-pump or CPB technique isused.